Let’s imagine that we live in an exotic parallel universe where I am able to use an amusing but trivial news event to illustrate a wider cultural and intellectual issue. Dr Andy Lewis runs a website called Quackometer: he criticised the Society of Homeopaths (Europe ’s largest professional organisation of homeopaths) in no uncertain terms.

In his opinion, and he amassed some examples: they do not enforce their own “Code of Practice” (you’re not even allowed to imply you can cure a named disease!) it is a figleaf; and they fail to censure their members over dangerous claims. His chosen example was the Newsnight malaria sting which you might remember: an undercover investigator went to see some homeopaths, and was given homeopathic pills to protect against this fatal disease, by quacks who denigrated medical options and failed to give basic “holistic” advice on things like bite protection. I agree with Dr Lewis: in my opinion their approach was cavalier and dangerous.

Did the SoH engage with these criticisms? Reflect on them? Challenge and rebutt them? No. They sent a threatening legal letter. Did this threatening legal letter say what was wrong with Dr Lewis’s post? No. It wasn’t even sent to him, it was sent to his hosting company Netcetera, demanding they take his page down. He contacted the SoH, very politely (I mean incredibly politely, read it here), to ask them what the problems were with his comments. No response.

Instead their lawyers sent another angry letter to his hosting company, who of course cannot investigate this in full, are strictly speaking liable, and so – good call – the page was taken down. Corporate conspiracy silences the little man: except of course his piece has now been replicated a hundred times across the internet by an army of smirking bloggers.

But how does the SoH approach – silence and repress – compare with other medical academic organisations? This week I was invited to be on a judging panel for a prize run by the Cochrane Collaboration, the international academic body that produces independent systematic reviews of the literature on all medical interventions: the prize (a thousand quid) is for the best piece of work critical of the Cochrane Collaboration.

Is this an isolated and esoteric example? The British Medical Journal is probably the most important medical journal in the UK (and certainly the most widely read). You might not know the kind of thing that appears in academic journals, but the BMJ recently announced the three most popular research papers from its archive, according to an audit which assessed their use by readers, the number of times they were referenced by other academic papers, and so on. Every single one of these papers was highly critical of either a drug, a drug company, or a medical activity, as its most central theme.

The top scoring paper was a case-control study which showed that patients had a higher risk of heart attack if they were taking the painkillers rofecoxib (Vioxx), diclofenac, or ibuprofen. Vioxx of course was at the heart of a major scandal. At number 2 was a large meta-analysis of drug company data, which showed no evidence that SSRI antidepressants increase the risk of suicide, but did find weak evidence for an increased risk of deliberate self harm, which is worth keeping an eye on. And in third place was a systematic review which showed an association between suicide attempts and the use of SSRI’s, and highlighted – very critically – some of the inadequacies around the reporting of suicides in clinical trials.

This is how ideas move forwards. Meanwhile, a survey of all the studies reported in 4 alternative medicine academic journals found that 1% of them – one per cent! – reported negative findings.

Of course there is a role for libel laws. If someone says you’ve bonked a rentboy and you haven’t, of course there is. If someone says you’ve taken corrupt money and you haven’t, of course. But when someone criticises your ideas, when someone challenges how well an organisation is running itself, especially when that organisation has a role in protecting the public from errant homeopaths who can, after all, in the process of cheerfully playing doctor, at the very least, sometimes, maybe, you know, forgive me for saying so, in my opinion, make some slightly worrying judgement calls… well you’d think they’d have the dignity to engage with that criticism, rather than ignoring and suppressing it.

References:

Audit identifies the most read BMJ research papers
BMJ 2007;334:554-555

I’m afraid I’ve shamefully stolen this huge quote from David Colquhoun, he is updating his list regularly so go there for the full one, but I thought it would amuse you to witness – visually more than anything else – the sheer scale of the response there has been to this hamfisted attempt at stifling discussion:

…well, “The Gentle Art of Homeopathic Killing”, the original title of the silenced blog post, now brings up a startlingly large number of hits. As you can see.

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If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks!
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If you Google “The Society of Homeopaths”, four or five of the ten links that you see on the first page now refer you to “The gentle art of homeopathic killing”. That is the page that they rried to suppress by legal action. It must now have been read by many thousands of people who would not have noticed it if the Society of Homeopaths had answered the questions put to them, rather than using bullying tactics to avoid the questions.

The power of the blogs was never more obvious. The Society of Homeopaths have shot themselves in the foot in a major way (but I expect they have a pill for that).

The make-believe world of homeopathy is now riven by internal ware as never before. The more responsible Faculty of Homeopaths is as appalled as anyone by claims to prevent or cure malaria by homeopathic pills. The much bigger Society is quite unashamed of such claims which can, of course. kill people. It seems that their lawyers have been spectacularly unsuccessful in their attempte to defend this wicked advice.

what i love about pseudoscience is that once you peel away the bollocks there’s always an interesting cultural issue nestling beneath:

there is nothing wrong with using a placebo in many situations, as i have said on many occasions.

it’s perfectly possible to imagine a safe way of giving out sugar pills, whilst being cautious about serious conditions like malaria and aids, missed diagnoses, not undermining vaccination campaigns, not denigrating evidence based medical treatments as part of your sales patter, not undermining the public understanding of science, etc.

it’s not the sugar pill that’s dangerous about homeopathy.

it’s the people, as very well exemplified here by the Society of Homeopaths.

MattCooper said,

An apporach might be to create a top-level domain for recording such commentary which is prepared to take on the task of hosting such materials and actually stand up to the legal threats. That would expose the attempts at censorship and maintain s record of it, keep the material visible and win some points.

Sounds like a job for a charitable institution and some charitable lawyers

ACH said,

Randi’s comments are around the semantics of the SoH’s wording of “treats” rather than Quackometer’s “cure”.

But, if that is the SoH’s concern, why can’t they engage in comment with the Duck rather than the heavy handed legal approach.

Becasue they know that the weasel wording is deliberatley designed to pull the wool over the eyes of the general public who do not give as much careful thought to the semantics of “treat” and “cure” when going off to see a homeopath with a self limiting disease, and from there extrapolate to homeopathic “cures” for fatal diseases.

Well done Andy and all the other bloggers who made sure that the SoH’s cowardly act has been exposed.

ACH the Code of Ethics states that:
To avoid making claims (whether explicit or implied; orally or in writing) implying cure of any
named disease.

The key word that hoists them on their own petard is ‘implied’. If they just left it at explicit then fair enough, using implied allows all kinds of semantic interpretations, most of which do not favour them.

On the subject of advertising cures, what about the claim by homeopath Helen Brewers, at homepage.ntlworld.com/nick.bewers/About%20Me.htm
on the “About Me” page of her website that she became interested in homeopathy after her daughter was “treated by a professional homeopath for asthma and successfully cured”? Would this fall into the category of advertising that “expressly or implicitly claims to cure named diseases.”? I reached this page via a link from the Society of Homeopaths’ website. She is one of their members. Does this constitute advertising a cure?

1. None of this would have taken place if the SoH had an open and transparent complaints procedure around their ethics code. Compare with the GMC and how they handle complaints (e.g. Wakefield). Their web site has all details of past and future hearings and published results. You can decide yourself if the GMC are doing a good job. SoH are closed and secretive.

2. Randi is quite right to pick into the semantics. It is what he does best and his million dollar challenge depends on the charlatans not being able to wiggle out on words. But, Gimpy is right too. SoH are clear that they do not want to ‘imply’ cures too.

3. Semantics and legal shenanigans aside, the most important issue in my opinion here is still the SoH support of homeopaths in dealing with things like AIDS – their forthcoming symposium on AIDS is on the 1st of December in London. This is the true scandal of the SoH. An ethics code is meaningless if what you do is fundamentally unethical.

4. Have just got off the red-eye cattle class from NYC (Big Pharma are not that generous with their cheques). But hope to post some more interesting stuff on the quackometer later today.

Ambrielle said,

I’ve brought this up before, but what exactly are ‘named diseases’? I get the feeling this is another language loophole for the homeopaths. I’m not an MD, but does ‘named diseases’ specifically refer toeponymous diseases, which the homeopaths rarely (although sometimes) refer to? Or is the meaning more general than that, and can refer to common terms such as asthma, cancer (of various types), various infections etc?

In contrast to Randi’s comments, I certainly think that claiming to “successfully treat” diseases is ‘implying’ a cure, but agree that they have very carefully chosen language to help avoid this issue.

sockatume said,

I think it means naming any specific disease, so they could say homeopathy works against general malaises like “the signs of aging” or “that oogy-boogy stuff which stops you attending your cheese and wine night”, but not that it “cures malaria”. Which sounds reasonable enough, seeing as placebo therapy genuinely does work against ill-defined malaises.

Well, if SoH’s lawyers send a letter to Ben’s hosting company they will get a rather different response.

Those rather cuddly people at Positive Internet Company wrote to me when they heard about the SoH threats and offered to host the quackometer. I have a few technical issues that make that a little tricky straight away, but bless their cotton socks.

All new bloggers sign up with them now!

Robert Carnegie said,

Ambrielle: do I take it that you’re joking that they remove “implied” cure from their terms of ethics not-do list?

On the reports on badscience, they might as well remove “ethics”. And I may not have the AIDS and colour therapy story straight(???) but if that “P.C.” guy is under their umbrella then they can drop “homeopaths”.

There -really- is no virtuous point in have a code of ethics that practitioners – if we call them that – aren’t tested against. If it’s just a scrap of paper.

Given what’s known about how placebo and lifestyle interventions can help people ethical bullshit is something that should be on the agenda today. If handled properly it could prevent fantasists getting a platform and be scientific. It’s about context though, and I don’t think it’s the sort of thing that would work well from GPs. The ritual is missing. I still like the idea of lifestyle doctors and lifestyle clinics but there is a horrible tendency towards that sort of thing becoming a patronising attempt at social engineering. Or like government health propaganda during WW-II and for a bit after.

pv said,

Gimpy, I’m interested to know in what way the SoH could become less ethical.
I don’t know if Ben will tolerate this but it is clearly dishonest to have a list of rules and describe it as a “code of ethics” if, whenever that code is put to the test it is ignored. This is not the action or attitude of a real professional body, in any sense or meaning of the word “professional”. It is however the action of organisations fronting, shall we say, rather more dubious or less than honest activities. Lets face it the SoH nor any of its members would publicly claim that you can treat or cure (choose your preferred word) HIV, malaria or any other non-self-limiting disease with sugar pills or tap water. Even they, I suspect, if it was put like that would agree it was dishonest. Well, maybe some wouldn’t.
With that in mind, am I allowed to say that it is dishonest to claim homeopathy represents a treatment or cure for any non-self-limiting disease. A treatment with no palliative or curative property is no more a treatment than say a letter to Santa Clause. It’s certainly not a cure. And to hide behind a placebo effect while claiming a medicinal effect appears to me also to be if not thoroughly dishonest then irretrievably deluded.

kim said,

Chris_Ch said,

Looking at some of the homeopathy websites and just generally following the debate it is noticable that those that advocate homeopathy very often put emphasis on how long it has been around. ‘Homeopathy has been around for so many hundred years etc…’ the implication being that that proves it works or that alone justifies it.

But how long was the idea of the ‘four humours’ around for? Hundreds of years, championed by Galen. How hard did Harvey, Vesalius etc have to work to overcome the entrenched ideas of medicine of their time. No doubt they were told, ‘this has been the way we have done things for 200 years etc etc’. Of course it was their questioning and those like them that gave birth to the Modern era and Modern medicine wasn’t it? There is the tale of the anatomist Silvius who, when what he saw in the body he cut up contradicted the ancient Galen, declared the body was wrong!

How long did we think the world was flat?, how long did we send children down mines, keep slaves etc? Ok this is not exactly in the same league, perhaps i’m being meoldramatic. But just to say soemthing has been around for centuries is not justification at all. I’m sure that arguement was used for all the things i mentioned above.

No doubt they see themselves as successors to modern medicine (medicine and modernism having failed in their eyes). But they are from the dark ages themselves, perhaps, if you’ll let me carry tyhe analogy a little further, that’s why they don’t want the light shined on them.

I think they have really shot themselves in the foot with this one! Great fun, i’ll not shed a tear

pv said,

Gimpy, I’m interested to know in what way the SoH could become less ethical.

Depressingly easily. E.g. they could start advocating treatments which are painful and/or actively harmful, as opposed to just ineffective.”

I think we’ve established that a non-remedy like homeopathy can, in the right (wrong) circumstances be deadly. In that sense claiming homeopathic remedies for malaria, AIDS and so on is an actively harmful activity. Ignoring the evidence, which even a non-scientist like me can understand, is… well, words fail me on that. It seems to me equally as unethical as advocating an actively harmful treatment.
You aren’t allowed to sell home-made cakes a village fète these days in case someone gets food poisoning, but any old deluded crank can legally persuade people not to seek proper medical advice or care by offering fraudulent/pretend medicine. And you can even get said pretend medicine, along with its associated and equally pretend advice, on the NHS. What kind of idiot law makers cobbled that lot together?

I think we’ve established that a non-remedy like homeopathy can, in the right (wrong) circumstances be deadly. In that sense claiming homeopathic remedies for malaria, AIDS and so on is an actively harmful activity. Ignoring the evidence, which even a non-scientist like me can understand, is… well, words fail me on that. It seems to me equally as unethical as advocating an actively harmful treatment.

hm, not quite as unethical. e.g. a non-remedy like homoeopathy as the only treatment for cardiovascular disease certainly can be fatal. However, some non-remedies (e.g. chelation therapy, removal of mercury fillings, etc.) can be worse than doing nothing – they can actually increase the chance of death, injury and suffering.

Not that I’m defending any of these practices, of course…

TP said,

The homeopaths Should have sent a delegate to the top of Mount Everest, where he would whisper, very quietly “Stop it”.
By the time the sound waves had been diluted by the winds and carried to the UK….

testtubebabe said,

Bugger! Have we shot ourselves in the foot? Havent the hatredopaths proved that a small thing has a giant impact? Still hate them though. Promised they would cure my son of his very severe asthma when tried them in desperation after about the hundredth asthma attack. Did they fuck, but still charged me.

pv said,

They have had complaints from other people and they have their own web site, together with the web sites of many “practitioners”, chock full of evidence of them contravening their own code of ethics. The ethics do appear to be homeopathically diluted though, because there isn’t a single molecule of them to be found in the SoH’s activities.
All this though is just a smokescreen to distract from the fact that homeopathy is not medicine. It has no medicinal properties nor active ingredients and, if I might paraphrase all the well run studies (as opposed to the SoH’s anecdata, fantasies and statistical anomaly scrapings), homeopathy is no more effective than a placebo (i.e. no better than warm words and doing nothing). What the SoH and all homeopathy practitioners are doing is akin to denying the observations of Copernicus and Galileo, and every astronomer since, in order to insist that the sun orbits the earth. A modern day Flat-Earth Society.
So, what’s the reason they persist with the charade and resort to bullying? There’s big money to be made exploiting the ignorant and vulnerable, and they don’t like it when they are exposed for what they are…

Robert Carnegie said,

Here’s another thought. Become a deeply unethical homeopath, join the SoH, and become publicly embarrassing to them as far as possible without breaking the law. Date your patients, that’s usually a biggie. See how long it takes for them to invoke a complaint procedure.

JQH said,

The SoH has no interest in disciplining its members. Remember the Newsnight/Sense About Science malaria sting? They took no action against their members and isued a weasle-worded press release which implieded that homeopathy can be used to treat malaria.

Robert Carnegie said,

No discipline? that’s great! Let’s launch a Society of Homeopaths range of sex toys incorporating the distinctive likenesses of well-known Bad Science people. I have in mind Gillian McKeith particularly, and I think you know where.

miranda said,

Having used both conventional medicine and homeopathy I have found that both offer benefits to health. In the face of a society where excess (over processed food, smoking, alcohol and drug abuse) is ruining the health of individuals, the NHS should be encouraging research into other therapies. As a homeopath and a science graduate I would be happy to conduct research on homeopathic treatment if I could access funding.

The idea that homeopathy is a threat to the funding of the NHS is a construction of media hacks. I have close family who work in the NHS and they can see that other therapies are needed to address health issues. We cannot keep patching people up with pharmaceutical drugs that produce side effects.

The services that the NHS has set up are clearly not serving everyone. I choose to visit and pay for my own treatment with my homeopath twice or three times a year. I choose this over visiting my GP who is being paid to care for me although I don’t attend while they may earn up to £250,000.

What are you trying to do on your bad science site?
It would be a very narrow minded person who says that just because they haven’t used homeopathy that they will go to extensive lengths to stop other people having access to it.

I wrote to you as I wanted you to know that I and other homeopaths are listening to all this negativity about homeopathy. A liitle bemused at your interest and the ferocity of the media attacks
Frankly I would like to know why you feel that we are such a threat? We our clients would not return for treatment if it didn’t work!

I suppose some science hacks must attack people as a way to earn a living. Now that is bad science.

nash said,

Someone I know is doing the Hoe Degree thru the University of Lancaster. The course is 30 days a year for 5 years which equates to 150 days of tution. Based on 8 hour days this is 1200 hours.
You don’t require a qualification in any science related subject to do the course.
Ethics is an optional module.

aggressivePerfector said,

I’m rapidly becoming a fan of your journalistic effort, but I have one nit-picking point to make.

Here, and in some other articles I’ve noticed (but not made detailed record of), you are guilty of exactly the kind of thing you strive to expose: not comparing like with like.

You tell us about the prevalence of negative results in the most popular articles in the BMJ, then compare that with the 1% occurrence of negative results in alternative medicine journals.

Why leave room for doubt? Why not print the corresponding figure for mainstream medical journals? (The negative results may have been popular due to their incredible rarity!) Why compare one particular mainstream journal, with (I am tacitly asked to assume) a representative survey of the ‘alternative’ literature?

Defenders of pseudoscience presented with your data may very well accuse you of being deliberately obscure, and their arguments may well work, because it may be that some of the people such arguments are aimed at are just the kind of people inclined to believe anything without checking the statistics for themselves.

Apologies for being verbose on a miniscule point, and for failing to be “combative, intelligent, and rude.” Keep up the good writing.